Abstract Large off‐track Hill‐Sachs lesions present a significant challenge in the management of recurrent anterior shoulder instability, particularly in young, active patients. Traditional Hill‐Sachs management procedures include remplissage, coracoid transfer and free bone block reconstruction, which all carry associated limitations, including non‐anatomic reconstruction, donor‐site morbidity, risk of resorption, and/or glenohumeral contour mismatch, in addition to the risk of insufficient restoration of the glenoid track in the setting of a large off‐track Hill‐Sachs lesion. The fresh talus allograft free bone block has recently emerged as an excellent alternative source for a Hill‐Sachs lesion, given its close anthropometric match to the humeral head, robust articular cartilage, and variable graft sizing options. The purpose of this Technical Note is to describe a detailed, reproducible technique for the preparation of a fresh talus osteochondral allograft for reconstruction of a large off‐track Hill‐Sachs lesion.
Nocek et al. (2026) studied this question.